Utilization Review Expert Witnesses

Utilization review expert witnesses and consultants listed here may be able to form expert opinions, draft expert witness reports, provide expert witness testimony at deposition and/or trial as or serve as consulting (non-testifying) experts on utilization review. The utilization review expert witness listings on this page are typically from fields/areas of expertise such as: Hospitalist, Insurance, Internal Medicine, Long Term Care, and Medical Management.

John H Gong, MD LG Healthcare LLC

Kildeer, Illinois
Internal Medicine, Hospitalist - Outpatient Internal Medicine, Hospital Medicine, Nursing Home Medicine, Nursing Home Medical Director, Hospice Medical Director, Utilization Review, Geriatrics, Family Medicine Residency, Medical Education
I have 26 years of experience as a practicing internist and hospitalist. I have 10 years of experience in academic medicine when I was clinical faculty teaching family practice residency physicians in both outpatient internal medicine and inpatient hospital medicine. I won the Gold Apple Teaching award almost every year I was clinical faculty even though I'm an internist teaching in a family practice residency program. I'm an expert in the clinical scope of expertise of outpatient internal medicine, family medicine, and hospital medicine. I also have extensive experience in nursing home medicine and hospice care as I have been medical director for 4 skilled nursing facilities and 2 hospice agencies. I also have experience with hospital utilization review as a medical advisor for Centegra Health Systems. I left my teaching position over 10 years ago to establish a hospitalist programs in 2 different hospital settings. I am now in private practice with both an outpatient practice...

Vera Dvorak, MD TD&P Consulting Inc.

Silver Spring, Maryland
Medical Management, Long Term Care - Home Healthcare, Managed Care, Transitional Care Management, Medical Necessity Determination, Long-Term Care Planning, Evidence-Based Care Guidelines Expert, Patient-Centered Care Expert, Geriatric Services, Utilization Review, Medical Valuation, Infectious Disease
Vera Dvorak, MD, has broad and extensive experience in a continuum of care, with over 40 years working in diverse healthcare settings including home health services, palliative care, and hospice. She has also served as medical director in all of these areas. Dr. Dvorak has been a practicing physician, a managed care executive, a strategic member of corporate leadership, and vice president and medical director of hospital-based care coordination. She has been in charge of the appeals department in various managed care organizations; and is the founder of transitional care management for one of the largest healthcare systems in Northern Virginia. Dr. Dvorak’s focus has been on medical necessity determination, appropriate discharge disposition with defined short and long-term care needs. She has been a proponent of consistently applying evidence-based care guidelines to support clinical decision-making on a case-by-case basis and across the continuum of care to maximize the potenti...

Zachary Lemon, DO

Northville, Michigan
Internal Medicine, Hospitalist - Diabetes, Hypertension, Hyperlipidemia, Covid 19, Coronavirus, General Practice, Geriatrics, Medical Management, Physician Assistant, Preventive Medicine, Physician Advisor, Utilization Review, COPD, Pulmonary Embolism, Telemedicine
I am Board Certified in Internal Medicine with 12+ years in clinical practice in both hospital and clinic settings. I have extensive experience in teaching/supervising physicians-in-training and have been received the "Humanism and Excellence in Teaching Award" from the American College of Osteopathic Internists. Additionally, I have served as a Physician Advisor and lead trainer for my hospital's "Communication in Healthcare" course.

Frank L Brown, Jr, MD, FACP, FACEP, FRSM, FCP(E)

Bluffton, South Carolina
Medical Management, Insurance - Accountable Care Organizations (ACO), Health Insurance, Grievances, Pharmacology, Provider Credentialing, Medical Management, Medical Necessity, Medicare, Medicaid, Healthcare Fraud & Abuse, Medical Billing & Coding, Medical Utilization, Utilization Review, Qui Tam
Senior physician executive in the health insurance industry, with licensure in Kentucky, North Carolina, Pennsylvania, and Virginia. Certified as Health Insurance Executive. National insurance companies worked for include Oxford Healthplans, Blue Cross & Blue Shield, Wellpoint, Anthem, and Cigna. Responsibilities have included case management, fraud and abuse, physician credentialing, peer review, physician grievances & appeals, patient grievance & appeals, and patient safety. Board-certified in both internal medicine, and emergency medicine. Holder of multiple patents. Experienced public speaker. Chief Medical Correspondent WVGB-FM in Beaufort, South Carolina. Yale-educated, NIH trained. Conducted over 5,000 physician credentialing reviews; over 5,000 medical necessity/utilization management reviews; patient & physician appeals, & hearings; and over 2,000 committee and in-person patient grievance & appeal reviews. Served as an Examiner for the Malcolm Baldrige National Quality...